Provider Demographics
NPI:1215140645
Name:ROSARIO, ANA IRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:IRIS
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HEMPTOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2509
Mailing Address - Country:US
Mailing Address - Phone:212-795-5200
Mailing Address - Fax:212-202-6101
Practice Address - Street 1:436 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3507
Practice Address - Country:US
Practice Address - Phone:212-795-5200
Practice Address - Fax:212-202-6101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0444361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01397795Medicaid